Provider Demographics
NPI:1194220897
Name:SOUTH CAMPUS PARTNERS, INC.
Entity Type:Organization
Organization Name:SOUTH CAMPUS PARTNERS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRPERSON & PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TERRENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:MOISAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-873-2450
Mailing Address - Street 1:2160 S 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:MAYWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60153-3328
Mailing Address - Country:US
Mailing Address - Phone:708-216-3708
Mailing Address - Fax:
Practice Address - Street 1:15300 WEST AVE BLDG A
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-4600
Practice Address - Country:US
Practice Address - Phone:708-873-2450
Practice Address - Fax:708-873-2455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-26
Last Update Date:2018-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0203XAmbulatory Health Care FacilitiesClinic/CenterOncology, Radiation